MSD Manual

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Steven D. Blatt

, MD, State University of New York, Upstate Medical University

Reviewed/Revised Oct 2021 | Modified Sep 2022

Adoption is the legal process of adding a person to an existing family. All adoptions must be validated by a court of law. Adoption, unlike foster care Foster Care Foster care is care provided for children whose families are temporarily unable to care for them. Guided by federal (national) laws, local government determines the process of arranging foster... read more , is meant to be permanent. The goal of adoption is to provide lifelong security to the child and the adoptive family. Currently, there are more than 2 million adopted children under the age of 18 in the United States.

Children who are orphaned are obvious candidates for adoption. In the United States, children can be adopted if the parents give up the child voluntarily or if the child is freed involuntarily through the court process known as termination of parental rights. International adoption (adoption of children from other countries, for example, from foreign orphanages) is also often possible.

There are many terms for the types of adoption in the United States, but adoption can be organized into three major categories:

  • Adoption from foster care

  • Independent adoption or private adoption

  • International adoption

Adoptions can be open or closed. In open adoption, the identities of the child, adoptive family, and biologic parents are known to one another. In closed adoption, the identities of the biologic parents and the adoptive family are kept confidential.

Adoption from foster care

Children whose biologic parents have had their rights terminated are considered free to be adopted. These are usually children in the foster care system. About 50,000 children are adopted each year from foster care, and many of the adoptive parents receive financial support to help cover the costs of the children's medical or special education needs (adoption assistance or subsidies).

Independent adoption or private adoption

Children can be adopted independently or privately, that is, a public agency is not involved in arranging the adoption. In these adoptions, biologic parents can use a private adoption agency to place a newborn with an adoptive family. Often, the adoptive family pays thousands of dollars to the agency for legal services and medical support for the biologic parents. At times, a private lawyer, rather than an agency, makes these arrangements.

Another type of private adoption can occur when a single parent marries or commits to a partner. Someone who marries a person who has a child does not automatically become the parent of that child. A child who does not have a second biologic parent can be adopted by the new spouse or partner.

International adoption

Although in the past more than 20,000 children from foreign countries were adopted by United States families each year, this number has decreased significantly. According to the U.S. State Department, in 2019, fewer than 3,000 children from other countries were adopted in the United States. The number was in even lower in 2020, likely due to the impact of the COVID-19 pandemic COVID-19 COVID-19 is an acute respiratory illness that can be severe and is caused by the coronavirus named SARS-CoV-2. Symptoms of COVID-19 vary significantly. Two types of tests can be used to diagnose... read more and travel restrictions. Families usually use an adoption agency based in the United States to arrange the adoption or use agencies or other professionals based in the child's birth country to make arrangements.

All adoptions from another country must be validated by a court of law in that country. Although such adoption is valid in the United States, families often choose to also go through an adoption process in the United States to avoid future challenges to the adoption.

After adoption

Most adopted children, including those previously in foster care or foreign orphanages, adjust well and develop few problems. However, as children age, they may develop feelings of rejection because they were given up by their birth family. During adolescence and young adulthood, in particular, adopted people may be very curious about their birth parents, even if they do not ask about them. Some adopted people seek information about, or seek out, their birth parents, and some birth parents seek out their birth children.

Not telling children they were adopted can hurt them later. It is best if this information is never considered a secret but is just considered part of the family history. If asked, adoptive parents should tell the child about the birth parents in a comforting manner. For example, if the child was abused Overview of Child Neglect and Abuse Child maltreatment includes all types of abuse and neglect of a child under the age of 18 by a parent, caregiver, or another person in a custodial role (for example, clergy, coach, or teacher)... read more Overview of Child Neglect and Abuse or neglected Overview of Child Neglect and Abuse Child maltreatment includes all types of abuse and neglect of a child under the age of 18 by a parent, caregiver, or another person in a custodial role (for example, clergy, coach, or teacher)... read more Overview of Child Neglect and Abuse , adoptive parents can say the child was removed because the birth parent had problems or was ill and could not provide proper care. Alternatively, adoptive parents may say that the birth parent was not able to care for the child and gave the child to the adoptive parents so they could love and take care of him or her.

Children need reassurance that they are loved and always will be loved. If children have contact with their birth families, it helps for parents to tell the children that two sets of parents love them.

Contact with birth parents

If birth parents request anonymity, there is controversy about whether children should be able to find information about them. Some states provide a web site for birth parents and children to post their identity. If both do so, then they will be placed in touch with each other. Contact cannot be initiated unless both parties agree. Widely available genetic testing now facilitates a person's, including an adoptee's, ability to find blood relatives they were unaware of.

Sometimes adoptive parents connect with birth parents. The parties may already be related in some way. For example, a stepparent can adopt a spouse's biologic child or grandparents can adopt their grandchildren. In other cases, parents may connect through word of mouth or newspaper advertisements.

Did You Know...

  • Some states have a web site that enables birth parents and adopted children to connect with each other if both parties want to.

More Information

The following are some English-language resources that may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

  • A resource providing all kinds of adoption information, including how to adopt and how to choose an adoptive family for a child

  • National Adoption Center: A resource providing information for people who want to adopt

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